1 Background

1.1 Driving Questions from JM Thome:

  • Analysis and correlation ( especially for the public health facilities ) of
    • general out-of-pocket health expenditure
      • OOP (Q3.3)
      • ( 3.5, 3.7),
    • FMNCH expenditure
      • Child Admittance (Q7.8.7-7.16)
        • OOP
        • Food
        • Transport
      • Mothers ( Q4.10, 4.18, 4.20, 5.18, 5.23, 5.28)
        • ANC OOP
        • Birth Cost
        • Birth Food Allowance
        • Birth Transport
    • HEF OOP expenditure (Q8.8-8.16)
  • Analysis of the main drivers of OOP payment for FMNCH services and for HEF members

2 General out-of-pocket health expenditure

2.1 Outpatient (Q3.3)

2.1.1 Number of Outpatient Cost Reports

Number of Outpatient Cost Reports By Facility
DH HC HV NH PC PH PP RH TH Total
PreID 41 91 13 1 7 47 37 1 0 238
GeoID 62 67 14 0 4 6 23 1 3 180
NoAssist 52 105 7 8 62 90 89 3 3 419
All 155 263 34 9 73 143 149 5 6 837

2.1.1.1 Total Outpatient Events

Total Num Outpatient Events
Care_At_DH Care_At_HC Care_At_HV Care_At_NH Care_At_PC Care_At_PH Care_At_PP Care_At_RH Care_At_TH Total
PreID 276 827 79 2 59 243 305 2 13 1806
GeoID 263 861 193 0 57 18 248 0 42 1682
NoAssist 330 779 72 9 273 403 763 6 23 2658
All 869 2467 344 11 389 664 1316 8 78 6146

2.1.1.2 Percent of Outpatient Events Sampled

Precent of Outpatient Events with reported costs
DH HC HV NH PC PH PP RH TH Total
PreID 14.9 11.0 16.5 50.0 11.9 19.3 12.1 50.0 0.0 13.2
GeoID 23.6 7.8 7.3 7.0 33.3 9.3 Inf 7.1 10.7
NoAssist 15.8 13.5 9.7 88.9 22.7 22.3 11.7 50.0 13.0 15.8
All 17.8 10.7 9.9 81.8 18.8 21.5 11.3 62.5 7.7 13.6

2.1.2 Outpatient OOP Rate Plots

2.1.3 Outpatien OOP Cost Plots

2.1.4 Outpatien OOP Tables

2.1.4.1 Outpatient Total Cost Reports OOP

Number of Outpatient Cost Reports By Facility
DH HC HV NH PC PH PP RH TH Total
PreID 41 91 13 1 7 47 37 1 0 238
GeoID 62 67 14 0 4 6 23 1 3 180
NoAssist 52 105 7 8 62 90 89 3 3 419
All 155 263 34 9 73 143 149 5 6 837
Number of No OOP Outpatient Cost Reports By Facility
DH HC HV NH PC PH PP RH TH Total
PreID 7 14 0 0 0 5 0 0 0 26
GeoID 8 44 0 0 0 0 0 0 0 52
NoAssist 9 9 0 0 0 1 0 0 0 19
All 24 67 0 0 0 6 0 0 0 97
Percent of Outpatient Cost Reports With 0 Total Cost By Facility
DH HC HV NH PC PH PP RH TH Total
PreID 17.1 15.4 0.0 0.0 0.0 10.6 0.0 0.0 10.9
GeoID 12.9 65.7 0.0 0.0 0.0 0.0 0.0 0.0 28.9
NoAssist 17.3 8.6 0.0 0.0 0.0 1.1 0.0 0.0 0.0 4.5
All 15.5 25.5 0.0 0.0 0.0 4.2 0.0 0.0 0.0 11.6

2.1.4.2 No-OOP in Outpatient Tranportation Cost Reports

Number of reported Transportation Costs
DH HC HV NH PC PH PP RH TH Total
PreID 41 91 13 1 7 47 37 1 0 238
GeoID 62 67 14 0 4 6 23 1 3 180
NoAssist 52 105 7 8 62 90 89 3 3 419
All 155 263 34 9 73 143 149 5 6 837
Number of reported 0 Transportation Costs
DH HC HV NH PC PH PP RH TH Total
PreID 8 18 9 0 1 5 10 1 0 52
GeoID 11 46 1 0 1 0 5 0 1 65
NoAssist 9 23 7 0 4 1 16 1 1 62
All 28 87 17 0 6 6 31 2 2 179
Percent of Reported Transportation Cost equal to 0
DH HC HV NH PC PH PP RH TH Total
PreID 19.5 19.8 69.2 0.0 14.3 10.6 27.0 100.0 21.8
GeoID 17.7 68.7 7.1 25.0 0.0 21.7 0.0 33.3 36.1
NoAssist 17.3 21.9 100.0 0.0 6.5 1.1 18.0 33.3 33.3 14.8
All 18.1 33.1 50.0 0.0 8.2 4.2 20.8 40.0 33.3 21.4

2.1.4.3 No-OOP in Outpatient Medical Fee Cost Reports

Number of reported Medical Fee Costs
DH HC HV NH PC PH PP RH TH Total
PreID 41 91 13 1 7 47 37 1 0 238
GeoID 62 67 14 0 4 6 23 1 3 180
NoAssist 52 105 7 8 62 90 89 3 3 419
All 155 263 34 9 73 143 149 5 6 837
Number of reported 0 Medical Fee Costs
DH HC HV NH PC PH PP RH TH Total
PreID 30 73 5 0 4 42 24 0 0 178
GeoID 57 65 1 0 4 6 18 0 1 152
NoAssist 20 51 3 2 30 41 48 0 1 196
All 107 189 9 2 38 89 90 0 2 526
Percent of Reported Medical Fee equal to 0
DH HC HV NH PC PH PP RH TH Total
PreID 73.2 80.2 38.5 0.0 57.1 89.4 64.9 0.0 74.8
GeoID 91.9 97.0 7.1 100.0 100.0 78.3 0.0 33.3 84.4
NoAssist 38.5 48.6 42.9 25.0 48.4 45.6 53.9 0.0 33.3 46.8
All 69.0 71.9 26.5 22.2 52.1 62.2 60.4 0.0 33.3 62.8

2.1.4.4 No-OOP in Outpatient Medicine Cost Reports

Number of reported Medicine Costs
DH HC HV NH PC PH PP RH TH Total
PreID 41 91 13 1 7 47 37 1 0 238
GeoID 62 67 14 0 4 6 23 1 3 180
NoAssist 52 105 7 8 62 90 89 3 3 419
All 155 263 34 9 73 143 149 5 6 837
Number of reported 0 Medicine Costs
DH HC HV NH PC PH PP RH TH Total
PreID 28 68 0 0 0 35 0 1 0 132
GeoID 43 61 0 0 0 5 0 0 0 109
NoAssist 16 28 0 0 0 26 0 3 0 73
All 87 157 0 0 0 66 0 4 0 314
Percent of Reported Medicine equal to 0
DH HC HV NH PC PH PP RH TH Total
PreID 68.3 74.7 0.0 0.0 0.0 74.5 0.0 100.0 55.5
GeoID 69.4 91.0 0.0 0.0 83.3 0.0 0.0 0.0 60.6
NoAssist 30.8 26.7 0.0 0.0 0.0 28.9 0.0 100.0 0.0 17.4
All 56.1 59.7 0.0 0.0 0.0 46.2 0.0 80.0 0.0 37.5

2.2 Inpatient (3.5,3.7)

2.2.1 Number of Inpatient Cost Reports

Number of Inpatient Cost Reports By Facility
DH HC HV NH PC PH PP RH TH Total
PreID 55 22 0 1 1 65 0 0 0 144
GeoID 112 23 3 0 5 17 1 0 0 161
NoAssist 57 33 0 8 4 124 2 0 1 229
All 224 78 3 9 10 206 3 0 1 534

2.2.1.1 Total Inpatient Events

Total Num Inpatient Events
Overnight_At_HC Overnight_At_DH Overnight_At_PH Overnight_At_NH Overnight_At_PC Total
PreID 28 81 83 1 0 193
GeoID 83 191 29 0 3 306
NoAssist 57 66 131 6 4 264
All 168 338 243 7 7 763
2.2.1.1.1 Total Inpatient Event Per Family Vs Reports
Number of families with more than 2 inpatient events:
[1] 83
Number of inpatient events which could not be reported:
[1] 172
Number of inpatient events which failed to provide cost information when possible:
   PreID    GeoID NoAssist      All 
      28       25       18       71 
Number of families with more than 2 Inpatient events
   PreID    GeoID NoAssist 
      16       42       25 
Number of events in these families
   PreID    GeoID NoAssist 
      61      184       93

2.2.1.2 Percent of Inpatient Events Sampled

Precent of Inpatient Events with reported costs
HC DH PH NH PC Total
PreID 78.6 67.9 78.3 100.0 Inf 74.6
GeoID 27.7 58.6 58.6 166.7 52.6
NoAssist 57.9 86.4 94.7 133.3 100.0 86.7
All 46.4 66.3 84.8 128.6 142.9 70.0

2.2.2 Inpatient OOP Rate Plots

2.2.3 Inpatien OOP Cost Plots

2.2.4 No-OOP in Inpatient Tables

2.2.4.1 No-OOP in Inpatient Total Cost Reports

Number of Inpatient Cost Reports By Facility
DH HC HV NH PC PH PP RH TH Total
PreID 55 22 0 1 1 65 0 0 0 144
GeoID 112 23 3 0 5 17 1 0 0 161
NoAssist 57 33 0 8 4 124 2 0 1 229
All 224 78 3 9 10 206 3 0 1 534
Number of No OOP Inpatient Cost Reports By Facility
DH HC HV NH PC PH PP RH TH Total
PreID 12 4 0 0 0 5 0 0 0 21
GeoID 9 10 0 0 0 2 0 0 0 21
NoAssist 8 2 0 0 0 2 0 0 0 12
All 29 16 0 0 0 9 0 0 0 54
Percent of Inpatient Cost Reports With 0 Total Cost By Facility
DH HC HV NH PC PH PP RH TH Total
PreID 21.8 18.2 0.0 0.0 7.7 14.6
GeoID 8.0 43.5 0.0 0.0 11.8 0.0 13.0
NoAssist 14.0 6.1 0.0 0.0 1.6 0.0 0.0 5.2
All 12.9 20.5 0.0 0.0 0.0 4.4 0.0 0.0 10.1

2.2.4.2 No-OOP in Inpatient Tranportation Cost Reports

Number of reported Transportation Costs
DH HC HV NH PC PH PP RH TH Total
PreID 55 22 0 1 1 65 0 0 0 144
GeoID 112 23 3 0 5 17 1 0 0 161
NoAssist 57 33 0 8 4 124 2 0 1 229
All 224 78 3 9 10 206 3 0 1 534
Number of reported 0 Transportation Costs
DH HC HV NH PC PH PP RH TH Total
PreID 13 6 0 0 0 5 0 0 0 24
GeoID 12 10 0 0 1 2 0 0 0 25
NoAssist 11 11 0 0 0 4 0 0 0 26
All 36 27 0 0 1 11 0 0 0 75
Percent of Reported Transportation Cost equal to 0
DH HC HV NH PC PH PP RH TH Total
PreID 23.6 27.3 0.0 0.0 7.7 16.7
GeoID 10.7 43.5 0.0 20.0 11.8 0.0 15.5
NoAssist 19.3 33.3 0.0 0.0 3.2 0.0 0.0 11.4
All 16.1 34.6 0.0 0.0 10.0 5.3 0.0 0.0 14.0

2.2.4.3 No-OOP in Inpatient Medical Fee Cost Reports

Number of reported Medical Fee Costs
DH HC HV NH PC PH PP RH TH Total
PreID 55 22 0 1 1 65 0 0 0 144
GeoID 112 23 3 0 5 17 1 0 0 161
NoAssist 57 33 0 8 4 124 2 0 1 229
All 224 78 3 9 10 206 3 0 1 534
Number of reported 0 Medical Fee Costs
DH HC HV NH PC PH PP RH TH Total
PreID 39 15 0 0 0 51 0 0 0 105
GeoID 99 22 0 0 2 12 1 0 0 136
NoAssist 18 12 0 1 1 30 0 0 0 62
All 156 49 0 1 3 93 1 0 0 303
Percent of Reported Medical Fee equal to 0
DH HC HV NH PC PH PP RH TH Total
PreID 70.9 68.2 0.0 0.0 78.5 72.9
GeoID 88.4 95.7 0.0 40.0 70.6 100.0 84.5
NoAssist 31.6 36.4 12.5 25.0 24.2 0.0 0.0 27.1
All 69.6 62.8 0.0 11.1 30.0 45.1 33.3 0.0 56.7

2.2.4.4 No-OOP in Inpatient Medicine Cost Reports

Number of reported Medicine Costs
DH HC HV NH PC PH PP RH TH Total
PreID 39 17 0 0 0 54 0 0 0 110
GeoID 100 22 0 0 3 13 1 0 0 139
NoAssist 20 13 0 3 2 52 0 0 1 91
All 159 52 0 3 5 119 1 0 1 340
Number of reported 0 Medicine Costs
DH HC HV NH PC PH PP RH TH Total
PreID 38 13 0 0 0 47 0 0 0 98
GeoID 77 19 0 0 0 8 0 0 0 104
NoAssist 17 3 0 1 0 20 0 0 0 41
All 132 35 0 1 0 75 0 0 0 243
Percent of Reported Medicine equal to 0
DH HC HV NH PC PH PP RH TH Total
PreID 97.4 76.5 87.0 89.1
GeoID 77.0 86.4 0.0 61.5 0.0 74.8
NoAssist 85.0 23.1 33.3 0.0 38.5 0.0 45.1
All 83.0 67.3 33.3 0.0 63.0 0.0 0.0 71.5

2.3 Detailed analysis of who does/does-not pay

2.3.1 Who are the no assist who do not pay?

41 have No-OOP 15 or are CU5 (37 %)

3 FMNCH expenditure

3.1 Child Addmitance event (Q7.8.7-7.16)

  • OOP Rates
  • Cost Breakdown
  • Food Allowances
  • Transport Allowances

3.1.1 OOP Rates

82 Families reported a child inpatient event.

Child addmittance events
PreID GeoID NoAssist All
Num Child Admit 27 26 29 82

The largers group of inpatient events are the GeoID in the distric hospitals.

Child Inpatient Report Counts by Facitly and Insurrance Group
PreID GeoID NoAssist All
PH 8 1 13 22
DH 13 22 11 46
HC 6 3 4 13
Other 0 0 1 1
Total 27 26 29 82

3.1.1.1 Barplot of OOP by facilty and Insurance Type

#### Percent Child Inpatient OOP by facilty and Insurance Type
OOP Percentages for Child Inpatient Reports by Facitly and Insurrance Group
PH DH HC Other Total
PreID 37.5 7.7 0.0 NaN 14.8
GeoID 100.0 36.4 0.0 NaN 34.6
NoAssist 69.2 27.3 50.0 100.0 51.7
All 59.1 26.1 15.4 100.0 34.1 
Warning in chisq.test(with(CA, table(CALoc, Child_Admitted_Cost_OOP))):
Chi-squared approximation may be incorrect
Pearson's Chi-squared test

data: with(CA, table(CALoc, Child_Admitted_Cost_OOP)) X-squared = 11.38, df = 3, p-value = 0.009839

3.1.2 Cost Breakdown

Overview plot of cost breakdowns for all child inpatient procedures reported

Remove outliers and break down by care facility:

3.1.3 Food Allowances

3.1.3.1 Number of cases that recieve food allowances

Number of Food Allowances by facility and Insurance type
PreID GeoID NoAssist All
PH 3 1 0 4
DH 8 14 2 24
HC 0 0 0 0
Other 0 0 0 0

3.1.3.2 Percent of cases that recieve food allowances

Percent of Food Allowances by facility and Insurance type
PreID GeoID NoAssist All
PH 37.5 100.0 0.0 18.2
DH 61.5 63.6 18.2 52.2
HC 0.0 0.0 0.0 0.0
Other NaN NaN 0.0 0.0

3.1.3.3 Plot of Food Allowance Amounts

3.1.4 Transportation Allowances

3.1.4.1 Overview of Transportation Allowance Reception for Child hospitalizations

3.1.4.2 Number of cases that recieve transportation allowance

Number of Transportation Allowances Recieved facility and Insurance type
PH DH HC Other
PreID 1 5 1 0
GeoID 1 10 0 0
NoAssist 1 0 0 0
All 3 15 1 0

3.1.4.3 Percent of cases that recieve transportation allowance

Percent of Transportation Allowances Recieved by facility and Insurance type
PreID GeoID NoAssist All
PH 12.5 100.0 7.7 13.6
DH 38.5 45.5 0.0 32.6
HC 16.7 0.0 0.0 7.7
Other NaN NaN 0.0 0.0

3.1.4.4 Number of cases within 3km

Number <3km (no transport) by Facility and Insurance type
PH DH HC Other
PreID 0 3 2 0
GeoID 0 2 2 0
NoAssist 0 0 0 0
All 0 5 4 0

3.1.4.5 Percent of cases within 3km

Percent <3km (no transport) by Facility and Insurance type
PH DH HC Other
PreID 0.0 23.1 33.3 NaN
GeoID 0.0 9.1 66.7 NaN
NoAssist 0.0 0.0 0.0 0.0
All 0.0 10.9 30.8 0.0

3.1.4.6 Plot Transportation Amount Recieved

3.2 MNCH Rates Birth Costs(Q4.10, 4.18, 4.20)

  • Mother OOP ANCs (Q4.10)
  • Birth Cost delivery (4.18)
  • Birth Hospital Food allowance (4.20)
  • Birth Delivery was at hospital more 3k

3.2.1 OOP ANCs (Q4.10)

Number of Mothers attending ANCs
   PreID    GeoID NoAssist          
      60       73      148      281 
36 Mothers attending ANCs had a child addmitance event
Number of Mothers reporting ANC OOP
   PreID    GeoID NoAssist          
       1        1        7        9 
Percent of Mothers attening ANC reporting OOP
   PreID    GeoID NoAssist          
       2        1        5        3 
Number of Mothers reporting ANC OOP having a child admitance event report
   PreID    GeoID NoAssist 
       0        1        1 
Number of Mothers reporting ANC OOP having a child admitance event report reporting OOP
   PreID    GeoID NoAssist 
       0        0        0

The 2 women who paid ANCs out of pocket and had inpatient child events in the same familly did not claim out of pocket payments on these children

3.2.2 Cost of Delivery (Q4_18)

Warning in loop_apply(n, do.ply): Removed 1 rows containing missing values
(geom_segment).
Warning in loop_apply(n, do.ply): Removed 1 rows containing missing values
(geom_segment).
Warning in loop_apply(n, do.ply): Removed 1 rows containing missing values
(geom_segment).

3.2.3 Birth Food Allowance (Q4_20)

Number of Hospital Births
   PreID    GeoID NoAssist      All 
      29       13       90      132 
Number of Hospital Births Recieving Food Allowance
   PreID    GeoID NoAssist      All 
       8       10        8       26 
Percent of Hospital Births Recieving Food Allowance
   PreID    GeoID NoAssist      All 
      28       77        9       20

Serial Number 34 fails to report the food allowance information

3.2.3.1 Plot Food Allowance Reciept for Hospital Births

3.2.4 Birth Transportation Transportation Allowance

3.2.4.1 Plot Transportation Amount Recieved

3.2.4.2 Compare Transportation Allowance to previous

              
               Not Recieved Recieved <3k
  Not recieved           11        1   1
  Recieved                1        2   0
  <3k                     0        0   1

3.3 Child Illness

3.3.1 Cost of Last Diarhea (5.18)

Number of Child Diarhea events:
   PreID    GeoID NoAssist      All 
      39       55       65      159 
Number of Child Diarhea OOP:
   PreID    GeoID NoAssist      All 
       8       20       26       54 
Percent of Child Diarhea OOP:
   PreID    GeoID NoAssist      All 
      21       36       40       34

3.3.2 Cost of Respitratory Treatment (5.23)

Number of Child Resp events:
   PreID    GeoID NoAssist      All 
      52       58      112      222 
Number of Child Resp OOP:
   PreID    GeoID NoAssist      All 
      11       21       53       85 
Percent of Child Resp OOP:
   PreID    GeoID NoAssist      All 
      21       36       47       38

3.3.3 Cost of Fever Treatment (5.28)

Number of Child Fever events:
   PreID    GeoID NoAssist      All 
      30       23       47      100 
Number of Child Fever OOP:
   PreID    GeoID NoAssist      All 
       3       10       19       32 
Percent of Child Fever OOP:
   PreID    GeoID NoAssist      All 
      10       43       40       32

4 HEF OOP expenditure

4.1 Adult_Admitted_Cost_OOP Q8_8

Num Respondents to HEF Admittance OOP Question
PreID GeoID   All 
   82   102   184 
Num Responding with OOP to HEF Admittance OOP Question
PreID GeoID   All 
   26    33    59 
Percent Responding with OOP to HEF Admittance OOP Question
PreID GeoID   All 
   32    32    32

4.2 Adult_Admitted_Cost Q8_9

4.2.1 HEF OOP Cost Average

4.2.2 HEF OOP Cost Drugs in Hospital

Number of HEF Admitts reporting OOP and 0 Drug Costs in Hospital
PreID GeoID   All 
    9    12    21 
Percent of HEF Admitts reporting OOP report 0 Drug Costs in Hospital
PreID GeoID   All 
   35    36    36

4.2.3 HEF OOP Cost Drugs out of Hospital

4.2.4 HEF OOP Cost Service Charge

4.3 Adult_Admitted_Food_allowance Q8_10

Percent of OOP/No-OOP Recieving Food allowance
No-OOP OOP Sum
Not Recieved 22.8 19.6 42.4
Recieved 45.1 12.5 57.6
Sum 67.9 32.1 100.0
Number of OOP/No-OOP Recieving Food allowance by Group
1 2 3 4 5 6
1 “Group” “PreID” “GeoID” “Sum”
2 “FoodAllowance” “OOP”
3 “Not Recieved” “No-OOP” 14 28 42
4 “OOP” 17 19 36
5 “Sum” 31 47 78
6 “Recieved” “No-OOP” 42 41 83
7 “OOP” 9 14 23
8 “Sum” 51 55 106
9 “Sum” “No-OOP” 56 69 125
10 “OOP” 26 33 59
11 “Sum” 82 102 184
Percent of OOP/No-OOP Recieving Food allowance by Group
1 2 3 4 5 6
1 “Group” “PreID” “GeoID” “Sum”
2 “FoodAllowance” “OOP”
3 “Not Recieved” “No-OOP” 8 15 23
4 “OOP” 9 10 20
5 “Sum” 17 26 42
6 “Recieved” “No-OOP” 23 22 45
7 “OOP” 5 8 12
8 “Sum” 28 30 58
9 “Sum” “No-OOP” 30 38 68
10 “OOP” 14 18 32
11 “Sum” 45 55 100

4.4 Adult_Admitted_Food_allowance_amount Q8_11

4.5 Adult_Admitted_Outside_HEF_3km_radius

4.6 Adult_Admitted_Transport_allowance_amount